Autoimmune Hepatitis

What is autoimmune hepatitis?

Autoimmune hepatitis is a rare condition which can cause chronic hepatitis; hepatitis itself is a term used to convey swelling of the liver. If autoimmune hepatitis is not treated and managed effectively it can be one of the most serious forms of hepatitis. Autoimmune hepatitis was previously recognised as chronic active hepatitis, although it is now classified as a specific disease.

Autoimmune hepatitis is not common in the UK and only has an impact on around 1 in 10,000 individuals. It can affect both sexes and people of all ages but tends to be most common among women aged between 40 and 50. The disease is more common in women than men with around 7 in 10 cases involving women.

What causes autoimmune hepatitis?

The exact cause of autoimmune hepatitis is unknown. Autoimmune diseases affect the immune system, the body’s natural defence system against illnesses and infections. It is believed that autoimmune conditions cause the body to mistake body tissue for harmful threats and thus the body starts to attack itself. It is not fully understood why this happens but there is evidence to suggest that some things, such as viruses or exposure to certain chemicals, can trigger an autoimmune response.

Symptoms of autoimmune hepatitis

For the majority symptoms tend to develop gradually over a period of 1-6 months. Common symptoms of autoimmune hepatitis include:

• Fatigue.
• Generally feeling unwell.
• Joint pain.
• Becoming tired easily.
• Struggling to complete a full day’s work.
• Feeling tired constantly.

Less common symptoms include:

• Nausea.
• Weight loss and loss of appetite.
• Abdominal pain.
• Bloating.
• Indigestion.
• Jaundice (when a yellow colour becomes apparent in the whites of the eyes and on skin).
• Bruising easily.

In some cases symptoms can develop very quickly, which is known as acute hepatitis. Symptoms include:

• Fever (a high temperature).
• Feeling sick.
• Abdominal pain.
• Jaundice.

There is also the likelihood that the disease may become more severe and cause cirrhosis of the liver, which is scarring to the liver tissue. Symptoms of cirrhosis include vomiting blood, abdominal pain and swelling and muscle wasting.

How is autoimmune hepatitis diagnosed?

In most cases the symptoms for autoimmune hepatitis are fairly general and it can take an extended time for people to see their GP and get a diagnosis. Many people are diagnosed when they are having tests for different conditions. Autoimmune hepatitis is usually diagnosed by a series of tests, including:

• Blood tests, specifically liver function tests (these show the level of function of the liver).
• An ultrasound scan of the liver (this is to establish the extent of the inflammation).
• Additional blood tests to find out more about the condition.
• A biopsy test (this involves taking a tiny piece of liver tissue and analysing it under a microscope).

Treating autoimmune hepatitis

If autoimmune hepatitis is treated effectively the outlook is positive, though the disease can be serious if it is left untreated. Treatment for autoimmune hepatitis usually involves:

• Steroids: steroids are used to ease inflammation. Prednisolone is the most commonly used steroid medication for autoimmune hepatitis. Initially a high dose will be prescribed and this will be reduced gradually. It is not advisable to have long courses of high dose steroids as they can cause unpleasant side-effects. Doctors aim to find the smallest dose of steroids for each individual and therefore the dose will differ according to the patient.
• Immunosuppressant medication: a type of immunosuppressant drug, known as Azathioprine, is used to reduce the action of the immune system. It is frequently used alongside steroids and is only prescribed once inflammation is being controlled effectively by the steroids. Other medications may be prescribed and your doctor will discuss any changes in medication with you.

Most people have long-term treatment for autoimmune hepatitis and patients are advised to visit their physician regularly to ensure close monitoring of the condition. If you are diagnosed with autoimmune hepatitis you will probably be advised to cut down on drinking or to avoid drinking altogether. This is because alcohol causes the liver to develop swelling and can contribute to cirrhosis, especially in people already with hepatitis.

In extreme cases, when the disease is diagnosed at a very advanced stage or an individual has severe cirrhosis, a liver transplant could be the only treatment option. A transplant involves replacing the damaged liver with the liver from another person. There is a shortage of donors and it can take a long time for a healthy liver to become available. Transplant surgery is complex and carries risks, which will be outlined by a specialist in the event of an individual going through with a transplant procedure.

Side-effects

Steroids can cause side-effects and this is why doctors aim to keep doses relatively low once the irritation has been brought to a level where it can be managed. Possible side-effects of steroids include:

• Increased appetite and subsequent weight gain.
• Diabetes.
• Fluid retention (this can cause you to feel bloated and the legs and arms to appear swollen).
• Indigestion.
• Thinning of the hair.